You be the Judge: Understanding and Evaluating the Quality of Human Cryopreservations from Cryonics Organization Literature and Case Report Data, Part 2

When cryonics began in the 1960s, the mission of the 4 cryonics societies[1] that more or less simultaneously came into existence at that time was fairly homogenous:

1) Make cryopreservation available to their members using the most advanced techniques available while seeking to minimize any post-cardiac arrest ischemic injury, and to continue and defend the cryopreservation of members until such time as resuscitation becomes possible (i.e., indefinitely),

2) Support scientific research to advance and perfect cryopreservation methods, and to generally support research in biomedicine that would facilitate resuscitation of cryopreserved patients,

3) Promote cryonics to the general public and the professions as a potentially viable mechanism for medical time travel,

4) Foster research into interventive gerontology and life span extension and work to extend the lives of members and conserve their health, delaying cryopreservation as long as possible,

5) Rehabilitate and reintegrate their cryopatients into the society or culture extant at the time that revival becomes feasible.

During the 1980s, and continuing throughout the 1990s, divergence from this model began to occur. In particular, the Cryonics Institute began to define its services and activities around a low cost model which emphasized a simplified cryopreservation procedure with minimal/no emphasis on avoiding warm or cold ischemic injury and withdrawal from any interface with or intervention in the member’s medical care. In this model of cryonics, the cryonics organization becomes actively involved only after medico-legal death has been pronounced and a licensed Funeral Director takes custody of the patient and makes the removal from the home, hospital, ECF, or facility where the patient was pronounced legally dead. CI members can elect to have Standby and Stabilization services through a third party service provider, such as Suspended Animation, Inc., of Boynton Beach, FL, though the majority of CI members do not make such arrangements.[19]

Alcor has continued to follow the prototypical cryonics society model to a greater degree, but appears to be no longer actively involved in trying to extend its members’ life spans by promoting risk reduction or health maintenance strategies, and it also appears to have ceded its activity in supporting and promoting interventive gerontological research to other organizations.[20] Contemporary cryonics organizations have thus effectively chosen to confine the scope of their operations to cryopreserving and storing their members, with or without aggressive attention to minimizing ischemic injury. Understanding these distinctions is crucial in any attempt to evaluate the performance of individual cryonics organizations, or of their service provider(s).

Measuring Quality in Cryonics

The easiest place to start in the case of trying to measure the quality of care in cryonics is at the beginning. That’s because the initial phases of the procedure very closely overlap conventional medical procedures, where hundreds of millions of dollars and countless man-years of effort have been expended developing both direct and surrogate feedback for the effectiveness of the procedures used. It might be expected that I am now about to launch into a discussion of the mechanics of providing closed-chest and extracorporeal circulatory support, or the induction of hypothermia. In fact, these interventions occur considerably downstream from the point where truly effective care of the cryopatient actually (ideally) begins.

In a very real sense, that care starts the moment the member/patient experiences his first contact with the cryonics organization that will ultimately cryopreserve him. The tenor of that first contact will likely determine the nature and course of the member’s subsequent interaction both with cryonics and his cryonics organization. If cryonics is presented as a developed product that is costly but nevertheless fairly routine, say like buying a home or an automobile, that’s very likely how it will be subsequently be treated. If, on the other hand, there is heavy emphasis on the lack of infrastructure to provide help in an emergency and the need to exercise both personal responsibility and personal preparedness, outcomes will likely differ – at least statistically, if not in each individual case.

It isn’t necessary for the reader to agree with all the criteria I am about to set out, although if you do not agree with any of them, then this article clearly isn’t for you, and you may stop reading at that point. It also isn’t the case that I’m going to cover all the bases here. To my knowledge, this is the first time that such an effort has been undertaken, and I am guaranteed to omit important elements of good care, as well as to include some which are superfluous. This is a draft document, input is welcome (indeed essential), and if it is to have any meaningful effect on the course of affairs in cryonics, this document will have to become an organic one – something that interacts dynamically and intelligently with the community it seeks to serve.

First Contact

First contact with a cryonics organization by a Prospective Member (PM) usually occurs in one of three ways: via the organization’s website, through printed literature designed for recruitment, or through a phone call to the organization’s representative(s). The critical elements which must be present in that first contact (depending upon the willingness of the PM) are:

1) If the contact is by phone or in person, is there a systematic procedure for establishing the level of understanding the PM has about cryonics? For instance, does the PM understand that the procedure is speculative, that it is not currently reversible (i.e., not suspended animation) and may never be, that it is not currently consistent with established medical and mortuary practice and that cooperation, or even non-interference by these institutions, may not be forthcoming? Do they understand the likely costs, and the general uncertainties that accompany choosing cryonics as a life extending option?

2) Is a printed handbook available which comprehensively discusses the following issues:

a) Definition and history of cryonics, which is understood to include a narrative of cryonics, including its origin, significant historical milestones (e.g., the cryopreservation of the first man, Chatsworth, legal and cryobiological milestones, and so on) and its current status.

b) Explication and discussion of the various criteria for defining life and death, and how these contrast with the information-theoretic criterion used by most contemporary cryonicists.

c) Discussion of the time-course of post-cardiac arrest biochemical and structural changes and how these are known to impact viability and to degrade tissue structures currently thought to be critical to encoding memory and personality; the likely determinants of personal identity.

d) Thorough explanation and discussion of the currently available cryopreservation modalities and what their limits are in preserving the structures thought to encode personal identity when applied under optimum conditions (i.e., straight freezing, low level cryoprotected freezing, moderate and high level cryoprotected freezing and vitrification and incomplete vitrification). Known kinds of injury must be discussed in detail and illustrated photographically in such a way that the layman can grasp the degree and extent of the damage.

e) What are the likely obstacles to optimum cryopreservation and their frequency of occurrence in the organization’s membership population? What are the ways that individual members can both assess and reduce their risks of suffering these kinds of complications?

f) What is the impact of the various complications or obstacles to optimum, or even severely compromised cryopreservation? What are the probable effects of varying periods of ischemia on subsequent cryoprotectant equilibration and the consequences of suboptimum cryoprotection on viability and ultrastructure? These examples should also be demonstrated graphically, using gross, histological and ultrastructural images of brain tissue from animals or humans cryopreserved under conditions which accurately simulate those being employed by the cryonics organization on its own patients.

g) Summary of the scientific literature and scientific evidence that supports the cryonics premise, as well as data which cast doubt on the workability of the procedure.

h) Exploration of the nature of personal identity and the controversies surrounding it and how these interact with the practice of cryonics. The literature should allow the PM to understand the spectrum of possible outcomes from cryopreservation, ranging from survival of the genome in the form of a clone to complete recovery of a continuing individual with memory and personality intact.

i) Explanation of various scenarios for repair of cryoinjury, reversal of age-associated, and other pathologies, and restoration of the patient to life, under both worst case and best case conditions.

j) The mechanics of the cryopreservation procedures the organization offers; whole body versus neuropreservation, Standby, Stabilization and Transport, Cryoprotective Perfusion, Deep Subzero Cooling and Long Term Cryogenic Care. Each of these procedures must be discussed in detail and illustrated with images that document the technology being used in such a way that the PM can understand its likely impact on himself and on his family and friends should it need to be applied in an attempt to save his life.

k) Thorough and complete explication of the legal and financial mechanisms, instruments and institutions that are being used to finance and maintain cryopreservation.

l) Costs, including a complete listing of, and charges for the infrastructure, capital equipment, and consumables employed to place a patient into cryopreservation and maintain him, indefinitely, in that state. This is understood to include financial transparency with quarterly, or at least annually prepared financial reports, preferably audited being available to members or prospective members.

m) Contingency plans for dealing with sociopolitical or economic upheaval or other changes that make the practice of cryonics problematic or impossible where the cryonics organization has its patient care (storage) facilities.

n) Explication of the terms and conditions under which cryopreservation arrangement can be terminated by either the member or the cryonics organization.

Perhaps the best example of this kind of comprehensive handbook was that published by the Alcor Life Extension Foundation in 1989, entitled Cryonics: Reaching for Tomorrow by Brian Wowk and Mike Darwin.[21]

Membership Years

Prospective members who become fully signed up members with cryopreservation arrangements must be continually educated both about the basics of cryonics (learning through repetition) and about changes and new developments in all spheres of the profession; medical, scientific, financial, legal, social and political.

Minimizing the Risk and Consequences of Sudden Cardiac Arrest (SCA)

Population studies, as well as a large number of prospective, randomized clinical trials have unequivocally established that the Mediterranean diet (also called the Cretan diet) is effective in increasing mean lifespan in humans [22-26] whilst dramatically reducing the burden of age associated degenerative diseases.[26-39] In fact, the Mediterranean diet (MD) is the only dietary intervention that has robust, Level I evidence-based support in the peer reviewed medical literature. It has been shown to dramatically reduce the incidence of the metabolic syndrome,[40-45] Type II diabetes,[46-55] atherosclerosis,[37, 38, 56-63] stroke, myocardial infarction,[60, 64-72] a number of cancers,[24, 73-86] and may reduce the incidence and severity of Alzheimer’s disease (AD) and some other age-associated dementias.[26, 87-100]

Since Sudden Cardiac Arrest (SCA) and AD represent the two most common risks for information-theoretic death in cryonicists, advocacy of the MD by cryonics organizations, and continuing education of their members about the benefits of the MD should be a high priority for all cryonics organizations. Indeed, the quality and quantity of scientific evidence for the morbidity and mortality reducing effects of the MD are now sufficiently well established that it might well be argued that failure to advocate this intervention constitutes negligence.

The cryonics organization also has an obligation to protect its members from the consequences of catastrophic sequelae resulting from sudden and unexpected medico-legal death. Such protection should include the existence and vigorous promotion of a cryonics emergency first aid program which empowers individual members and their families to act immediately in the event of sudden cardiac arrest (SCA) to initiate external cooling,[101-104] and where appropriate in the case of high risk members, to avail themselves of protection against undetected periods of prolonged warm ischemia by use of cardiac arrest and ‘man down’ detection systems and/or wearable or implantable defibrillators. [105]

Since approximately 1/3rd of members will be at risk of becoming Coroner’s or Medical Examiners (C/ME) cases preparations to reduce the risk of autopsy and to minimize the injury inflicted should it occur must be in place. Long before a member becomes a C/ME case the cryonics organization has an obligation to collect information that will help reduce delay and improve the chances of a more favorable outcome. The first step in doing this is to structure the cryonics organization ‘Membership Application’ so that all the personal information necessary to allow completion of the Death Certificate is both collected and present in the first Section of the Membership Application as shown below:

In addition to the member’s name, address, phone number and birth date, all 50 states and the US territories require additional information to complete the Death Certificate. This information is gathered for statistical purposes and is often difficult to acquire in a timely fashion at the time of legal death. Indeed, in a number of cases the author is familiar with, the next-of-kin did not know some of this information leading to long delays in completion of the Death Certificate and release of the member to the cryonics organization. The following is a list of all the information required by the states’ department of Vital Statistics. Not all of this information is required in every state; however, the list below covers the information required by the combined 50 US states and the US territories.

Full Legal Name

Street Address (residence). Note: This must be a physical address, not a P.O. Box or Rural Route Number in areas (typically rural) where this otherwise constitutes a legal address.

Date of Birth

Place of Birth: City, County, State/Province, Country

Birth Name (if different from legal name)

Race or Ethnicity

Spanish or Hispanic

City (of Country)

Social Security Number

U.S. Military Service, Branch, Dates Served (From and To)

Marital Status

Occupation (list number of years)

If Unemployed what was Occupation

Total years of education

Father’s Name and Birthplace: City, County, State/Province, Country

Mother Maiden Name and Birthplace: City, County, State/Province, Country

This information should be entered into the cryonics organization’s computerized database for rapid retrieval in the event it is needed. Paper copies should also be readily available at the cryonics organization’s headquarters in the event electronic access is not possible for some reason (power failure, IT difficulties, etc.).

End of Part 2

Footnote

[1] In order, they were the Cryonics Society of New York (CSNY), the Cryonics Society of California (CSC), the Cryonics Society of Michigan (CSM) and the Bay Area Cryonics Society (BACS). Of these, two organizations are still in existence, although using different names; CSM has become the Cryonics Institute (CI)/Immortalist Society (IS) and BACS is now the American Cryonics Society (ACS).

16. Cummins R, Chamberlain, DA, Abramson, NS, et al.: Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.Circulation 1991, 84:960-975.